Dependency and Withdrawal

The core features of alcohol dependence are tolerance, withdrawal, repeated unsuccessful attempts to cut down and giving up important social, occupational and recreational activities. People can be dependent without necessarily exhibiting all of the following symptoms.

The symptoms of alcohol dependence include:

• Unable to keep a drink limit.
• Increased tolerance to alcohol. However, in the later stages of alcohol dependence, there may be a decreased tolerance to alcohol as a result of liver and central nervous system damage.
• Difficulty in getting drunk.
• Spending a considerable time drinking.
• Organising the day around drinking.
• Missing meals.
• Memory lapses and blackouts.
• Restlessness without drink.
• Trembling after drinking the day before.
• Morning retching and vomiting.
• Sweating excessively at night.
• Withdrawal fits.
• Morning drinking.
• Hallucinations and delirium tremens.

When alcohol dependence is established, withdrawal symptoms are one of the cardinal features. Dependent drinkers often take a drink in the morning to stave off withdrawal symptoms, and early morning drinking is virtually diagnostic of dependency.

With increasing need to stave off withdrawal symptoms during the day, the person typically becomes secretive about the amount consumed and may hide bottles or carries them around in his pocket.

Strong cider and cheap wines may be drunk regularly to obtain the most alcohol for the least money.

Severity of dependence

There are a number of features of dependence that are associated with severe disability. These are:

• Withdrawal fits.
• Delirium tremens.
• Change in tolerance to alcohol. Although the initial symptom of alcohol dependence is an increased tolerance to alcohol, in the later stages of alcohol dependence, there may be a decreased tolerance to alcohol as a result of liver damage.

Withdrawal symptoms

When alcohol intake diminishes or stops, the vast majority of people who are dependent upon alcohol experience withdrawal symptoms. They usually occur 24 to 48 hours after withdrawal of alcohol, but occasionally take up to 10 days to appear. The earliest symptoms include; Tremulousness affecting hands, legs and the trunk [the shakes]; Agitation; Nausea, retching, sweating and insomnia. As withdrawal progresses, misperceptions and hallucinations may occur. Later there may be epileptic fits and delirium tremens [DTs] may develop.

Considerable support may be required from professionals to:

• Encourage people to stop drinking.
• Persevere with withdrawal symptoms.

Delirium tremens (DTs) is the most serious manifestation of alcohol withdrawal and tends to occur in people whose history of alcohol misuse extends over several years and who have physical complications. Following alcohol withdrawal there is a rapid onset of disorientation, hallucinations, fear, paranoid delusions, extreme tremor and agitation. The condition usually lasts for 3 to 4 days. Delirium tremens has a mortality of about 5%, and requires emergency admission to hospital.

Physical damage may result from a direct toxic effect on bodily organs, poor diet [resulting in lack of protein and B vitamins] and increased risk of accidents especially head injury.